First Name

Last Name

Address

City

Home Phone (example : (555)555-5555

Cell Phone Number

Email Address

Date you can start work?

Salary Desired

Do you have a High School Diploma Do you have a High School DiplomaYesNoGED

What hours can you work? What hours can you work?Full TimePart Time

What type of employment are you wanting? What type of employment are you wanting?RegularTemporary

Are you authorized to work in the U.S. on an unrestricted basis? Are you authorized to work in the U.S. on an unrestricted basis?YesNo

Have you ever been convicted of a felony? Have you ever been convicted of a felony?YesNo

Please explain

High School Name & Address

College Name & Address (leave blank if not applicable)

List any special skills or experience that you feel would help you in the position that you are applying for (leadership, organizations/teams, etc.

Please list three professional references not related to you, with full name, address, phone number, and relationship. If you don’t have three professional references, then list personal, unrelated references.

Work History (Job 1) Start with your present or most recent employment and work back. Use separate sheet if necessary. (INCLUDE PAID AND UNPAID POSITIONS) Title, Start Date & End Date, Company Name, Supervisors Name, Phone Number, Full Address, Duties, Reason for leaving, Starting and Ending Salary.

May we contact your present employer? May we contact your present employer?YesNo

Work History (Job 2) Include: Title, Start Date & End Date, Company Name, Supervisors Name, Phone Number, Full Address, Duties, Reason for leaving, Starting and Ending Salary.

Work History (Job 3) Include: Title, Start Date & End Date, Company Name, Supervisors Name, Phone Number, Full Address, Duties, Reason for leaving, Starting and Ending Salary.

I certify that the facts set forth in this Application for Employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements, omissions or misrepresentations may result in my dismissal. I authorize the Employer to make an investigation of any of the facts set forth in this application and release the Employer from any liability. The employer may contact any listed references on this application. I acknowledge and understand that the company is an “at will” employer. Therefore, any employee (regular, temporary, or other type of category employee) may resign at any time, just as the employer may terminate the employment relationship with any employee at any time, with or without cause, with or without notice to the other party. I certify that the facts set forth in this Application for Employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements, omissions or misrepresentations may result in my dismissal. I authorize the Employer to make an investigation of any of the facts set forth in this application and release the Employer from any liability. The employer may contact any listed references on this application. I acknowledge and understand that the company is an “at will” employer. Therefore, any employee (regular, temporary, or other type of category employee) may resign at any time, just as the employer may terminate the employment relationship with any employee at any time, with or without cause, with or without notice to the other party.YesNo